Healthcare Provider Details

I. General information

NPI: 1235139817
Provider Name (Legal Business Name): ALLEGHENY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 E NORTH AVE SUITE 107
PITTSBURGH PA
15212-4740
US

IV. Provider business mailing address

490 E NORTH AVE SUITE 107
PITTSBURGH PA
15212-4740
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-3376
  • Fax: 412-359-5094
Mailing address:
  • Phone: 412-359-3376
  • Fax: 412-359-5094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD451018
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD451018
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD451018
License Number StatePA

VIII. Authorized Official

Name: CINDY WALTEMIRE
Title or Position: PROVIDER ENROLLMENT SPECIALIST
Credential:
Phone: 412-330-5864